The cadaver lab is a rite of passage in medical school — those few months early on when we dissect a human body to better understand our anatomy. It’s grotesque: peeling back skin, separating muscle sinews, and sawing through bone.
It’s so emotionally jarring that young doctors in training often compartmentalize the experience, and this person before us becomes organs and bones we deconstruct in the pursuit of knowledge. We never learned our cadavers’ names. We never met their families. We knew nothing about them, other than they donated their bodies to our education.
So we made it up — entire lives, on the hint of a scar, or the color of nail polish, all so that the body before us stayed human. It was an act of empathy, a complicated one because it also ended up helping me cope with the trauma of dissecting a human body. But afterward, I wondered, in imagining the details of these lives, do we end up dehumanizing the people we are tasked to care for?
Earlier this year, I had a patient who died. He was homeless and suffered from chronic mental illness. Once again, I found myself standing over a lifeless human body.
As far as I knew, my patient was alone, and his illness made it impossible for him to clearly communicate his needs. His death was shocking and violent, as efforts to resuscitate someone often are. I was scrambling to find meaning in the fact that he was suddenly gone forever.
“Can we just take a moment for this man?” I asked my colleagues. “He has no one.”
As I had done in medical school, I created a story — I thought my patient was invisible, and maybe, unloved. That story ended up being as far from the truth as is possible, and his reality was far more heartbreaking than I could have imagined in that moment.
Through some miracle of social work, we were able to track down his family, and they rushed to the hospital to be with the son and the brother they had lost long ago to mental illness. As my patient had detached from his family, they had never stopped looking for him. His elderly father used to drive around and wait outside shelters for a glimpse of his son, to know that for a minute, he was alive.
They never stopped loving him. He wasn’t alone. He was cared for in the only way his family could.
Losing that patient was one of the most traumatic experiences of my budding career. But the way I chose to cope — creating a story for him, asking my colleagues to remember him as I thought he was — has made me realize that I might have been well-meaning, but my act of compassion served no one but me.
There’s an animated film called “Kubo and the Two Strings,” about a boy who must learn about his family and his past to defeat a villain. In that defeat, the villain loses his memory, and rather than remind him of the evil and sadness he had wrought, Kubo fills his head with fake memories of happy deeds.
I hated it.
“We need to remember all the bad things, so we don’t risk reliving our mistakes,” I told my husband. “We can’t just rewrite people’s stories when it’s expedient.”
But, of course, that is exactly what I had done. It was easier, or more expedient, for me to suffer the loss of a dreamed-up nobody, rather than the loss of a real somebody.
As my patient’s mother sobbed on my shoulder, my arms around her, I silently asked for her forgiveness for minimizing her son’s life — and doubting her unconditional love for him. With this experience, I’ve recognized that empathy also means being able to imagine all my patients’ possibilities, even the ones that are hard to stomach.
“I don’t understand this disease,” his mother cried. “He had so many places to live.”
I was blown away by the attacks on Dr. Adaeze for incoherence, emotionality, and failure to glean a psychosocial assessment of psychotic patient. Anyone who works in the field of mental health, particularly in the ER (as I have), should be able to appreciate the challenges of assessing, admitting, and discharging patients in crisis. It is easy to write off patients who make it harder for us to do our jobs. It seems to me that you missed the point. Rather than simply checking the patient off her punch list, Dr. Adaeze attempted to humanize this man. So she later found out she got the story wrong (and admitted it). It takes a lot of emotional fortitude to actually bear the sadness of such patients’ lives (and deaths). Much easier to write them off as a case. Among other things, I admire Dr. Adaeze’s humility in sharing a less-than-perfect performance. Kudos to you, Dr. A
I did not realize that the author was a psychiatry resident, until after reading the article, and looking at Twitter account.
When your job is to provide mental healthcare, “making up stories about patients” means you are failing to look for the biopsychosocial information needed to provide meaningful care. “Making up stories” means you are making assumptions about diagnostically significant information. You hurt patients when you assume facts not in evidence.
As a family member of a person with schizophrenia who sometimes relapses to the street, and as a social worker – it is disheartening that the author fails to explore or even address the medical significance of her error.
We are all vulnerable to arrogance, and an MD inventing details about her patient’s life, when social history is diagnostically relevant – is a symptom of arrogance… whether or not it feels that way.
It is a painful truth that the “miracles of social work” were inaccessible to this patient until after his death.. that time when the coroner’s office had to identify next of kin in order to relieve the hospital and itself from custody of the body.
Sadly normal for a social worker (such as myself) physician, nurse, cop to think he/she knows a mentally ill, homeless person well enough to persuade themselves that his/her acute suffering doesn’t require social work intervention.
There are many, many ways for every public institution and provider to avoid really seeing, nevermind taking responsibility for, an actively psychotic homeless man. Until, after he’s dead – then, you must make every effort to dispose of the body with respect.
When 77 patients died, we knew the NECC tainted medication and senior company management had caused it.
WHAT? The article is incoherent. Emotion is not a substitute for thought. We need to press this point in our declining education system. Maybe less superfluous diversity training and more courses in college-level writing and critical thinking.
As a person who has lost several loved ones to cancer, and a cancer researcher myself who may now also have cancer, given the sheer enormity and complexity of life-and-death in medical research, for the most part I try to compartmentalize and rationalize things things as much as possible to be objective, but emotion is also a large part of who we are as humanity, and to deny that is pure rubbish. Part of the problem with so-called modern medicine today is that it IS so devoid of emotion. Many doctors, especially male doctors, treat patients as mere slabs of meat – inanimate objects to be merely “treated”. Thank you, Dr. Okwerekwu, for sharing your insights.
While the piece could have used a good edit, it’s far from “incoherent.” Obviously key details are missing, but that’s no doubt to protect the family’s privacy.
Your non sequitur about “superfluous diversity training” revealed what your real agenda was.
This was wonderful. one of your best articles yet.
This is a tremendous article. We so often read about medical situations from the patient’s view. Loved this.
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